Gastroesophageal reflux causing respiratory distress and apnea in newborn infants

Herbst, John J.; Minton, Stephen D.; Book, Linda S.

doi:10.1016/s0022-3476(79)80733-7

Cited by 295 publications

(114 citation statements)

References 8 publications

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“…Acid reflux into the esophagus has been shown to be temporally associated with oxygen desaturation and obstructive apnea, suggesting that esophageal reflux may be one of the underlying conditions in selected infants presenting with BRUEs. 101 Respiratory symptoms are more likely to be associated with GER when gross emesis occurs at the time of a BRUE, when episodes occur while the infant is awake and supine (sometimes referred to as "awake apnea"), and when a pattern of obstructive apnea is observed while the infant is making respiratory efforts without effective air movement. 102 Wenzl et al 103 reported a temporal association between 30% of the nonpathologic, short episodes of central apnea and GER by analyzing combined data from simultaneous esophageal and cardiorespiratory monitoring.…”

Section: B Clinicians Should Not Prescribe Acid Suppression Therapymentioning

confidence: 99%

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Tieder¹,

Bonkowsky²,

Etzel³

et al. 2016

Pediatrics

138

154

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This is the fi rst clinical practice guideline from the American Academy of Pediatrics that specifi cally applies to patients who have experienced an apparent life-threatening event (ALTE). This clinical practice guideline has 3 objectives. First, it recommends the replacement of the term ALTE with a new term, brief resolved unexplained event (BRUE). Second, it provides an approach to patient evaluation that is based on the risk that the infant will have a repeat event or has a serious underlying disorder. Finally, it provides management recommendations, or key action statements, for lower-risk infants. The term BRUE is defi ned as an event occurring in an infant younger than 1 year when the observer reports a sudden, brief, and now resolved episode of ≥1 of the following: (1) cyanosis or pallor; (2) absent, decreased, or irregular breathing; (3) marked change in tone (hyper-or hypotonia); and (4) altered level of responsiveness. A BRUE is diagnosed only when there is no explanation for a qualifying event after conducting an appropriate history and physical examination. By using this defi nition and framework, infants younger than 1 year who present with a BRUE are categorized either as (1) a lower-risk patient on the basis of history and physical examination for whom evidence-based recommendations for evaluation and management are offered or (2) a higher-risk patient whose history and physical examination suggest the need for further investigation and treatment but for whom recommendations are not offered. This clinical practice guideline is intended to foster a patient-and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient outcomes, support implementation, and provide direction for future research. Each key action statement indicates a level of evidence, the benefi t-harm relationship, and the strength of recommendation.

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Section: B Clinicians Should Not Prescribe Acid Suppression Therapymentioning

confidence: 99%

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Tieder¹,

Bonkowsky²,

Etzel³

et al. 2016

Pediatrics

138

154

View full text Add to dashboard Cite

show abstract

“…Unfortunately, as inlaryngomalacia, we have a poor understanding of the mechanism that underlies reflux-induced stridor. A strong case can be made for laryngospasm as at least one possible etiology for this disorder; Herbst et al showed that esophageal instillation of acid in infants led to laryngospasm [27]. This is further supported by a canine study by Bauman et al demonstrating reflux induced laryngospasm can occur through not only a direct laryngeal chemoreflex, but from distal esophageal afferent stimulation as well [8].…”

Section: Promentioning

confidence: 96%

Does Reflux Have a Causative Role in Laryngomalacia?

Manaligod¹

2013

Otolaryngology

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“…Healthy term and preterm newborn infants normally regurgitate feedings for several days to several wk after birth, but by two months of age this usually subsides (16). A small % of all infants without hiatal hernia exhibit symptoms of GER which persist abnormally into later infancy, often necessitating treatment.…”

Section: Speculationmentioning

confidence: 99%

Ontogenic Studies of Gastrointestinal Function. II. Lower Esophageal Sphincter Maturation in Neonatal Beagle Puppies

1982

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SummaryThe purpose of the present study was to investigate the postnatal development of lower esophageal spincter (LES) competence in the beagle and to determine the role of gastrin in LES functional ontogeny. Eleven beagle puppies taken from two litters were studied. All puppies were allowed to suckle during the first 3 postnatal wk. In the 4th wk, all puppies were weaned, and by the 5th wk only solid chow was offered. Intraluminal manometric pressure determinations were obtained in unanesthetized, unsedated puppies using twin-lumen, 1.7 mm OD, 1 mm ID polyvinyl catheters. A 12-15 min baseline period of intraluminal pressure was monitored, after which the puppies received successive doses of 0.03, 0.1, 1.0, and 8.0 pg/kg pentagastrin (PC) SC spaced at 45-min intervals.Progressive increases in LES pressure both during basal periods and during gastric contractions and in gastric fundus (GF) pressures during gastric contractions occurred during the 1st 5 weeks of life. An increase in pressure gradient between the LES and GF during gastric contraction occurred from birth through 5 wk of age. There was no response to 0.1-8.0 pg/kg PG until postnatal days 5-6 when the LES pressure gradient in the basal state increased in response to each of these doses. There was also no significant response by the LES to PG during gastric contraction until days 11-12 when all doses of PG evoked enhancement of LES pressure.These studies suggest that an increase in LES-GF intraluminal pressure gradient develops during the initial 2 postnatal wk in this species and that this development does not involve the hormone gastrin. Later, however, the pressure gradient may depend upon both age and gastrin since a two-way analysis of variance indicated that nit only is LES pressure affected bypostnatal age and by PG dose. but that there is an interaction between ~ostnatal age and PG dose which is significant. By the fifth wk, there was an apparent dose-response effect in which the lower two doses produced increased LES pressure and the larger two doses produced decreased LES pressures. SpeculationGastroesophageal reflux (GER) in some infants may occur when the developmental interplay between endogenous gastrin concentration, increasing sensitivity to gastrin by LES, and sensitivity to gastrin by the muscular stomach proceeds abnormally. Alternatively, either the postnatal increase in LES muscle mass or the maturation of a neural pathway that mediates reflex contraction of the LES during gastric contraction, or both, may be delayed or abnormal in some children with GER. A fourth possible abnormality that may permit GER in still other infants is failure to generate the increasing gastric contraction rate and intraluminal pressures observed to occur in normal development, thus permitting delayed gastric emptying.Functional incompetence of the lower esophageal sphincter (LES) that results in gastroesophageal reflux (GER) is a common problem in infants (6,15,20,23,24,28,29). Healthy term and preterm newborn infants normally regurgitate feedings for ...

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Gastroesophageal reflux causing respiratory distress and apnea in newborn infants

Cited by 295 publications

References 8 publications

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Does Reflux Have a Causative Role in Laryngomalacia?

Ontogenic Studies of Gastrointestinal Function. II. Lower Esophageal Sphincter Maturation in Neonatal Beagle Puppies

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